慢性肾脏病门诊口服中成药应用现状调查与分析

作者	单位
余仁欢	中国中医科学院西苑医院肾内科
翁俊雄	广州中医药大学第二临床医学院
汪涛	北京大学第三医院肾内科,北京,100191
苏国彬	北京大学第三医院肾内科
鲁新红	北京大学第三医院肾内科,北京,100191
刘壮竹	广州中医药大学第二临床医学院
刘旭生	广东省中医院肾内科
李文婧	广州中医药大学第二临床医学院
高辉	北京中医药大学2008级西苑医院
陈君忆	北京大学第三医院肾内科,北京,100191

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中文摘要:

目的了解西医院慢性肾脏病(chronic kidney disease,CKD)门诊口服中成药应用现状。方法对2009年5月北京大学第三医院肾内科门诊就诊、符合慢性肾脏病诊断标准的慢性肾脏病患者,以访谈加问卷形式进行调查。采用《慢性肾脏病门诊口服中成药应用现状调查表》收集患者以下信息:(1)目前症状、舌象、脉象,参考中华中医药学会肾病分会2006年《慢性肾衰的诊断、辨证分型及疗效评定》标准进行中医辨证分型;(2)患者目前使用的中成药及西药名称、用药剂量,开具中成药的医院名称;(3)患者目前的基础疾病:糖尿病、高血压、高尿酸血症等。依据药物说明书及2010年国家中医药管理局发布《中成药临床应用指导原则》拟定中成药不合理应用情况分类,对CKD患者中成药使用合理性进行分析。采用Logistic回归模型对可能导致中成药不合理应用发生的相关因素如年龄、性别、中医本虚证、中医标实证、中成药处方医院的性质及级别、所用药物总数目、中成药总数目、原发病等进行分析。结果共发放问卷102份,有效问卷78份,其中正在服用中成药制剂的CKD患者共41例占52.6%(41/78)。存在不合理应用例数占总服中成药例数58.5%(24/41),药证绝对不符占12.2%(5/41),药证相对不符占34.1%(14/41),重复用药占17.1%(7/41),存在药物相互作用占4.9%(2/41)。采用Logistic回归分析,用Enter法筛选变量,回归方程变量"中成药数目"差异有统计学意义(P<0.05)。结论西医院中慢性肾脏病门诊患者中成药不合理应用发生率较高,主要体现于药证不符及重复用药,处方中成药数目增多将增加中成药不合理应用发生率。

英文摘要:

Objective To investigate the current state of oral administration of Chinese patent medicine in treatment of chronic kidney disease (CKD) in the Western medicine hospitals.Methods Outpatients of Department of Nephropathy,Peking University Third Hospital with diagnosed CKD confirmed by CKD diagnosis standard were surveyed by questionnaire in May 2009.The following patients’ information was collected using the Questionnaire of the Current State of Oral Administration of Chinese Patent Medicine at CKD Clinics.(1) The present symptoms,tongue figure,pulse figure were syndrome typed referring to The Diagnosis,Syndrome Typing,and Efficacy Assessment of Chronic Renal Failure 2006 by Chinese Society of Renal Diseases,Chinese Society of Traditional Chinese Medicine.(2) Names of Chinese patent medicines and Western medicines patients use presently,the dose and dosage,names of hospitals responsible for prescriptions.(3) Patients’ basic diseases including diabetes,hypertension,hyperuricemia,and so on at present.Irrational applications of Chinese patent medicines were classified according to the drug instruction and Guiding Principle of Clinical Application of Chinese Patent Medicines (issued by State Administration of Traditional Chinese Medicine).The irrationality was analyzed.Correlated factors such as age,sex,deficiency in origin syndrome,sthenia in superficiality syndrome,the nature and grade of hospitals responsible for prescriptions,total numbers of Chinese patent medicines,and primary diseases,etc.were analyzed using Logistic regression model.These factors might result in irrational application of Chinese patent medicines.Results 102 questionnaires were handed out,with 78 effective ones.Of them,41 patients (41/78,accounting for 52.6%) were taking Chinese patent medicines.Of the 41 patients,irrational application happened to 24 patients (24/41,accounting for 58.5%),absolute discrepancy of medicines and syndromes to 5 (5/41,accounting for 12.2%),repeated medication to 7 (7/41,accounting for 17.1%),and interaction to 2 (2/41,accounting for 4.9%).Logistic regression model was analyzed.Variables were screened by Enter method.The number of Chinese patent medicines had statistic significance (P<0.05).Conclusions The occurrence rate of irrational application of Chinese patent medicines in CKD outpatients in Western medicine hospitals was higher.They were mainly manifested as absolute discrepancy of medicines and syndromes and repeated medication.Increased numbers of Chinese patent medicines in recipes would increase the occurrence rate of irrational application of Chinese patent medicines.

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